Dr. Burstein on the Treatment Landscape of HER2+ Breast Cancer

Harold J. Burstein, MD, PhD, senior physician, associate professor of medicine, Harvard Medical School, Dana-Farber Cancer Institute, discusses the treatment landscape of HER2-positive breast cancer.

Early-stage HER2-positive breast cancers have a very good prognosis, explains Burstein. Physicians tend to use anti-HER2 drugs in combination with chemotherapy to prevent disease recurrence. Women who have higher-risk disease are generally managed with chemotherapy alongside trastuzumab (Herceptin) and pertuzumab (Perjeta). That was informed by the results of the APHINITY trial, in which patients were randomized to trastuzumab and pertuzumab or trastuzumab alone. The trial showed that there is a significant benefit to the addition of pertuzumab for higher-risk cancers.

For stage I HER2-positive breast cancer, paclitaxel and trastuzumab can be used. A 400-patient prospective study led by Sara Tolaney, MD, of Dana-Farber Cancer Institute, examined that regimen and demonstrated a very low risk of recurrence of less than 4% in women who received the combination. For higher-stage cancers, physicians will add more chemotherapy and anti-HER2 drugs, states Burstein.